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  • August 8, 2018
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Tradition under the microscope — how images of germs can improve hygiene

In a study in rural Pakistan, showing villagers microbes led to stark hygiene improvements

“Seeing is believing” runs the phrase — and new research suggests that when it comes to germs, it may hold true. A study in rural Pakistan has found that residents who were shown microbes under a microscope were more likely to improve their hygiene over the long term than those who took part in conventional hygiene workshops.

The findings suggest that low-cost behavioural nudges could be transformative for rural and traditional communities in particular, where erroneous understandings of infection can still hold sway. The stakes are high: half a million people die from diarrhoea every year, an entirely preventable disease whose spread is aided by poor hygiene practices.

But can simple nudges really change deep-rooted social norms?

Show or tell?

The Microbe Literacy program trial took place in Pakistan’s southern Punjab province, and findings were released in July. One group was given microbe literacy classes, where participants were able to observe microbes under a microscope but weren’t explicitly taught about germ theory and its links to disease. Several days later, participants received an infection prevention workshop, where students were taught how better hygiene, like hand washing, can prevent infection. A second group received only the infection prevention class, while a third control group received neither.

Measured on a three-point scale, participants who were shown germs under the microscope improved their hygiene by 0.14 points, while those who only received conventional instruction barely changed their behaviour. Over 16 months this result grew to 0.16 points.

The report’s authors suggest that seeing microbes helps overcome the “belief barrier.” For villagers unfamiliar with microbes, lessons without demonstrations can’t convince people of their existence. In turn, the authors suggest that the retention of hygienic behaviour is likely due to positive reinforcement, as the villagers notice the health benefits that come from it over time.

“Around 40% of healthcare in China is traditional, while in Chile 71% of the population have used it”

These findings could help to tackle one of the world’s biggest killers. Diarrhoea remains the second leading cause of death for children under five years old in the world, but in most cases, it’s easily preventable. Simple improvements in hygiene — hand washing and handling food safely — can all help to reduce the risk of the infections which often cause it.

Diarrhoea can be particularly dangerous in remote and rural areas, where access to clean water and sanitary latrines is limited. Improving these often requires time and significant investment. Microbe literacy, by contrast, is quick and, at $4.95 per participant, relatively cheap; it aims to lower the number of infections which lead to diarrhoea by encouraging changes in behaviour.

Resilient traditions

Traditional medicine practices can exacerbate the challenge of convincing rural dwellers of the benefits of improving their hygiene. For believers in Unani medicine, the most common traditional medicinal system in Pakistan, disease is caused by an imbalance of the body’s “humours”, or elements.

In an attempt to restore balance, some Unani believers will respond to diseases like diarrhoea by denying themselves, or their children, food and water. Certain foods are considered “hot”, some “cold” — an excess of either can unbalance the corresponding humour in the body.

“Seeing microbes helps overcome the ‘belief barrier'”

Such beliefs had an impact in the trial: the microbe literacy lessons failed to shake strong believers from their convictions. Though there was a short-term increase in hygiene for that group, it didn’t shake the idea that withholding water or milk can kill the infection.

Traditional medicine remains popular across the world, particularly in remote and rural areas. Around 40% of healthcare in China is traditional, while in Chile 71% of the population have used it.

In comparison to other interventions such as water purification, behavioural nudges could prove a cost-effective and enduring way to improve health in rural areas. But microbe demonstration may never suffice to shake the most devout.  Anoush Darabi

(Picture credit: Flickr/Dave Thomas)

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